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Correct Injection Code Simplifies Billing for Cardiac Catheterizations by Gau Gan

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Correct Injection Code Simplifies Billing for Cardiac Catheterizations by
Article Posted: 05/08/2012
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Correct Injection Code Simplifies Billing for Cardiac Catheterizations

Cardiac catheterization, particularly left heart catheterization (LHC), is a three-step process: Place the catheter, inject dye for imaging, and supervise and interpret images that the angiograms produce.

Although there are considerably fewer injection codes than catheterization codes and even fewer supervision and interpretation (S&I) codes, some of the injection code descriptors might confuse anyone not yet strong on cardiac anatomy and medical terminology.

Clear and accurate documentation greatly simplifies code selection. The cardiologists notes should document the number of injections, the arteries or heart chambers receiving injections, and the type of heart catheterization performed.

Injection codes differ based on the anatomic area injected. Although the cardiologist can report injections in more than one location, each code can be billed only once, regardless of the number of injections made, says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.

For example, injections are typically made in two locations during an LHC (93510, Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous), each of which may be reported separately. These are 93543 (Injection procedure during cardiac catheterization; for selective left ventricular or left atrial angiography) and 93545 ( for selective coronary angiography [injection of radiopaque material may be by hand]).

Both 93543 and 93545 may be reported separately. Even if more than one angiogram of the coronary arteries is taken, however, 93545 may be reported only once. Separate payment should not be sought for separate injections of different coronary arteries, such as the left anterior descending (LAD) artery and right coronary artery (RCA).

Five of the seven injection codes are used with LHC only (93539, 93540, 93543, 93544 and 93545); the other two (93541 and 93542) are used with right heart catheterization (RHC, 93501) only.

Cardiologists may take pulmonary pressures during a right heart catheterization, but this does not necessarily mean that pulmonary angiography was performed, notes Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas. An injection must be performed to report 93541, so coders must ensure the cardiologist documents actually injecting and imaging the pulmonary artery, she says.

The other injection codes are used as follows:

If arterial conduits such as the left and right internal mammary arteries or radial arteries are imaged, use 93539 ( for selective opacification of arterial conduits [e.g., internal mammary], whether native or used for bypass]). Although it has been suggested that 93539 should be used only for bypass grafts, the descriptor makes it clear that 93539 is also meant to report imaging of native arterial conduits, Fuller says.

For bypass grafts of coronary arteries, report 93540 ( for selective opacification of aortocoronary venous bypass grafts, one or more coronary arteries).

Aortic angiograms performed with LHC are reported as 93544 ( for aortography).

Note: When aortography is performed and there is no accompanying heart catheterization or coronary angiography, neither 93544 nor 93556 (the corresponding S&I code) should be reported. Instead, use 36200 (Introduction of catheter, aorta) and the appropriate radiology code (75600-75630). ….

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Related Articles - Cardiology codes, Correct Injection Code, Billing for Cardiac Catheterization, medical coding, medical billing, icd-9 codes, cpt codes, hcpcs codes,

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